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J. S. Huang, G. N. Holland, C. S. Denove, F. Yu; Chronic Anterior Uveitis in Children: Causes of Vision Loss. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3777.
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Numerous studies have documented a substantial risk of decreased visual acuity (VA) among children with uveitis. We determined the incidence and individual causes of vision loss among a cohort of children with chronic anterior uveitis (CAU).
Retrospective chart review of all children (age ≤16 yrs. at disease onset) with CAU who were examined by 1 clinician (1993-2006). Demographic, medical and ophthalmic data were collected. Children with VA ≤20/50 or ≤20/200 were identified, and causes of vision loss at presentation or during follow-up were determined.
Among 200 eyes with CAU (115 children), 47 eyes (33 children) had VA ≤20/50 at presentation or during follow-up; 27 eyes (14 children) had VA ≤20/200. Vision was <20/200 in both eyes of 7 children. Median follow-up (n=83 patients) was 23.5 mos. Incidence of vision loss to ≤20/50 and ≤20/200 during follow-up was 4.4 and 3.7 per 100 eye-years (EY), respectively. Patients at risk for amblyopia (<8 yrs) had a higher incidence of vision loss (5.5/100EY) than older patients (3.5./100EY), although the difference was not significant (p=0.18). Eyes with complications at presentation, but with VA >20/50, continued to lose vision during follow-up, even without new complications (incidence, 5.9/100EY). The most common cause of vision loss was cataract (19 of 47 eyes). Less common contributors to vision loss included amblyopia, glaucoma, inflammatory membranes, band keratopathy, hypotony, and posterior segment complications. Macular edema was uncommon. The proportion of eyes with VA ≤20/50 at the time complications were identified was 19 (22.4%) of 85 eyes (17 children) with cataract, and was 4 (7.5%) of 53 eyes with glaucoma. No patient had vision loss attributed to band keratopathy alone. Uncorrected refractive errors were also common (15 of 47 eyes).
Vision loss in children with CAU is common, even among those who are treated. The most common causes of vision loss are potentially reversible. Understanding the course and causes of vision loss will help to monitor children appropriately for vision-threatening complications of disease; to plan visual rehabilitation; and to develop strategies to prevent vision loss.
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